V10-11 ROBOTIC CYSTECTOMY WITH ANTERIOR PELVIC EXENTERATION: A SIMPLIFIED STEP-BY-STEP APPROACH

Abstract

You have accessJournal of UrologyBladder Oncology/Robotics1 Apr 2014V10-11 ROBOTIC CYSTECTOMY WITH ANTERIOR PELVIC EXENTERATION: A SIMPLIFIED STEP-BY-STEP APPROACH Idir Ouzaid, Jayram Krishnan, Vishnu Ganeshan, Riccardo Autorino, Nima Almassi, Iryna Makovey, Robert Stein, Jihad Kaouk, and Georges-Pascal Haber Idir OuzaidIdir Ouzaid More articles by this author , Jayram KrishnanJayram Krishnan More articles by this author , Vishnu GaneshanVishnu Ganeshan More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Nima AlmassiNima Almassi More articles by this author , Iryna MakoveyIryna Makovey More articles by this author , Robert SteinRobert Stein More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Georges-Pascal HaberGeorges-Pascal Haber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2460AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic cystectomy with anterior pelvic exenteration (RCAPE) is feasible and is a minimally invasive approach for managing bladder cancer in females requiring cystectomy. We describe a simplified, standardized technique that removes many technical limitations while adhering to all oncologic principles. METHODS Ports are placed in the standard cystectomy fashion as previously described in the “W” configuration with a 12 mm assistant port on the right side of the patient. The patient is placed in the steep Trendelenberg position and the robot is docked. The ureters are dissected followed by posterior dissection with assistance of a malleable retractor in the vagina. Lateral dissection is performed to develop the pedicles and vaginal walls which are then secured using the Caiman© Tissue Sealing Device (Aesculap, Center Valley PA). Finally, the dorsal venous complex and urethra are divided. We routinely perform intracorporeal ileal conduit urinary diversion according to our described technique. RESULTS Between August 2011 and October 2013 we have performed 25 RCAPE using this standardized technique. Operative time including pelvic exenteration, vaginal closure, bilateral extended pelvic node dissection and intracorporeal ileal conduit urinary diversion was an average of 355 minutes and estimated blood loss was an average of 347 mL. One patient required a blood transfusion and length of hospital stay was an average of 6 days. Finally, complications were assessed according to the Memorial-Sloan Kettering Grading System and 3 patients had minor (grades 1-2) complications and 2 patients experienced major (grades 3-5) complications. CONCLUSIONS Robotic cystectomy with anterior pelvic exenteration can be performed using our simplified technique safely with minimal difficulty. Our technique is reproducible with excellent oncologic outcomes and allows for rapid progression to intracorporeal urinary diversion if desired. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e909-e910 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Idir Ouzaid More articles by this author Jayram Krishnan More articles by this author Vishnu Ganeshan More articles by this author Riccardo Autorino More articles by this author Nima Almassi More articles by this author Iryna Makovey More articles by this author Robert Stein More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...